KEITH DAVID CLANCY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

ACTIVE

Business

First Name

KEITH

Middle

DAVID

Last Name

CLANCY

Suffix

Business Name

KEITH DAVID CLANCY MD

Original Issue Date

07/27/1995

Effective Date

08/07/2023

Expiration Date

07/31/2026

City

FORT WAYNE

State

Zip

46825

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/07/2023